Evaluation of Sustained Intraocular Pressure Elevations Across Antivascular Endothelial Growth Factor Agents

Purpose: To evaluate the effect of antivascular endothelial growth factor (anti-VEGF) agents on the development of sustained intraocular pressure (IOP) elevations. Methods: This single-center retrospective cohort study included eyes receiving anti-VEGF injections for various indications along with nontreated fellow eyes from 2012 to 2022. Patients were grouped according to treatment with bevacizumab, ranibizumab, or aflibercept. Trends in IOP were recorded after treatment initiation for 1 year. The development of sustained IOP elevations (defined as an increase of 5 mm Hg or greater than baseline for 4 or more weeks) and glaucoma manifestations were recorded. Results: The analysis included 1604 eyes (injection cohort, 907; control cohort, 697). The mean age of the injection cohort was 83.3 years; 56.9% were women and 82.0% were White. Injections were for neovascular age-related macular degeneration (498 [54.9%]), diabetic retinopathy (219 [24.1%]), retinal vein occlusion (161 [17.8%]), and other indications (29 [3.2%)]. Bevacizumab was used in 521 eyes (57.4%), ranibizumab in 129 eyes (14.2%), and aflibercept in 257 eyes (28.3%). The mean age in the control cohort was 81.6 years; 56.1% were women and 84.1% were White. Sustained IOP elevations developed in 97 (6.0%) of 1604 eyes throughout the study. Compared with controls, treated eyes overall did not have an increased rate of sustained IOP elevations (P = .38) or glaucoma progression (P = .51), although patients treated with bevacizumab had a significantly greater incidence of IOP elevation than controls (relative risk, 1.81; 95% CI, 1.18-2.78). The mean number of injections to sustained IOP elevation was 5.4 and did not differ between agents (P > .05). Conclusions: Although not all anti-VEGF agents are associated with IOP-related adverse effects, bevacizumab carries an increased risk for sustained IOP elevation. Further investigation into the long-term effects of bevacizumab on IOP and glaucoma and a comparison with other anti-VEGF agents may be warranted.